Question Period Note: HEALTH FUNDING AGREEMENTS AND TRANSFERS

• What is the Government of Canada doing to support provincial and territorial health care systems in Canada?

KEY MESSAGES
• The pandemic has highlighted the need for resilient health care systems in Canada. That is why our government is committed to working collaboratively with provinces and territories to provide pandemic supports and to strengthen Medicare.
• On March 25, 2021, our Government committed to provide provinces and territories with an additional $5 billion for health care, including a $4 billion one-time top-up to the Canada Health Transfer to support PTs to clear the backlog of procedures caused by the pandemic, and $1 billion to support vaccine roll-out.
• This is in addition to significant pandemic-related health system investments through the $19 billion Safe Restart Agreement, as well as $150 million for the rapid deployment of virtual care services.
• In fall 2020, given the toll that COVID-19 has taken on those living in long-term care facilities, our government further committed to up to $1 billion to support safe long-term care, and Budget 2021 proposes to provide $3B over five years to support provinces and territories in ensuring standards for long-term care are applied and permanent changes are made.
• Furthermore, our government continues to collaborate with provinces and territories on shared priorities, supported by targeted federal investments of $11 billion over 10 years for provinces and territories to improve access to home and community care and mental health and addiction services.
• Through this work, our Government will continue to work closely with provinces and territories in order to improve health care and health outcomes for Canadians across the country.

IF PRESSED ON MANDATE LETTER COMMITMENT ON PRIMARY HEALTH CARE
• There are almost 90,000 physicians in Canada, a record number, but access to care is still an issue for some Canadians.
• Our Government is committed to engaging with provincial and territorial counterparts, health professionals and experts to help make sure Canadians can access primary health care when they need it.

IF PRESSED ON FEDERAL FUNDING TO PROVINCES AND TERRITORIES
• Our Government will provide provinces and territories with over $43 billion in 2021-22 through the Canada Health Transfer, totalling over $235 billion over the next 5 years.
• The Government has also introduced legislation to provide an additional $5 billion in direct support to provinces and territories for health care, including steps to address backlogs, and vaccination roll-out. This includes a $4 billion, one-time top-up to the CHT.
• This investment supplements funding of $700 million to help ensure health care systems are ready for future waves of the virus, $740 million for vulnerable Canadians – including those in long-term care, home care, and palliative care – who are at risk of more severe cases of COVID-19, and $500 million in support and protection for people experiencing challenges related to mental health, substance use, or homelessness.
• In addition, targeted funding in Budget 2017 committed to $11 billion in new targeted funding over 10 years to provinces and territories to improve access to home and community care and mental health and addiction services.
• Since then, our government has made additional commitments to support provinces and territories in areas where resources are most needed and more recently targeted support has been announced for virtual care of 150 million and safe long-term care of over $1 billion, and $3 billion to ensure that standards for long-term care are applied and permanent changes are made.

IF PRESSED ON QUEBEC

• Our Government is committed to ensuring it is there to meet the needs of the people of Quebec, and continues to work with all provinces and territories to strengthen public health care.
• The Canada-Quebec home and community care and mental health and addiction services bilateral agreement will flow approximately $2.5 billion over 10 years in funds targeted to support home and community care and mental health and addiction services and reflects the principles of asymmetrical federalism as recognized in 2004.
• Our government also committed to new targeted funds for Quebec and other provinces and territories for virtual care, safe long-term care and support through the Safe Restart agreement.
• This is in addition to the Canada Health Transfer, which will flow over $9.7 billion to Quebec in 2021-22.
• Quebec will also receive $902.4 million as part of its share of the $4 billion, one-time top-up to the CHT. It will also receive a further $225.6 million to support COVID-19 immunizations.

IF PRESSED ON MEASUREMENT AND REPORTING

• The Government of Canada has consistently emphasized the importance of Canadians seeing results for the investments in mental health and home care.
• In the August 2017 Common Statement of Principles, federal, provincial and territorial Ministers of Health agreed to work collectively to develop a focused set of indicators to measure progress and report to Canadians.
• In 2018, Ministers of Health agreed to a set of pan-Canadian indicators to measure progress. The Canadian Institute for Health Information began reporting on the first of these indicators on an annual basis in 2019.
• In addition, provinces and territories have also included program-specific indicators in their bilateral agreements.

IF PRESSED ON LONG-TERM CARE
• Through Budget 2021 our Government announced $3 billion over five years, starting in 2022-23, to support provinces and territories in ensuring standards for long-term care are applied and permanent changes are made.
• This is in addition to our Government’s commitment of up to $1 billion for a Safe Long-term Care Fund, to help provinces and territories protect people in long-term care and support infection prevention and control.
• Through the Safe Long-Term Care Fund, provinces and territories are expected to use this investment to undertake priority activities, including hiring additional staff (such as personal support workers) or topping up wages, infrastructure improvements and readiness assessments for infection prevention and control.
• As a condition of funding, provinces and territories must provide a detailed plan, similar to what has been provided for home and community care and mental health and addiction services.
• The federal government will work collaboratively with provinces and territories, while respecting their jurisdiction over health care, including long-term care. This work would ensure seniors and those in care live in safe and dignified conditions.

IF PRESSED ON NEXT STEPS FOR BILATERAL AGREEMENTS

• The Government of Canada signed home and community care and mental health and addiction services bilateral agreements with all provinces and territories to flow $5 billion in targeted funding for home care and mental health from 2017-18 through 2021-22.
• We are now working with provinces and territories to amend those agreements to flow funding for the Safe Long-term Care Fund.
• A new round of bilateral agreements will be negotiated to flow the remaining $6 billion in funding starting in 2022-23.

BACKGROUND
Council of the Federation (CoF) Request for Increased in (CHT)
In September 2020, the Council of the Federation (CoF) made a formal request for an increase in health transfers to help address the PT projected increase in health care costs associated with COVID-19 and pressures such as an aging population, and new drugs/technology. The increase requested by CoF would have had the CHT rise to $70 billion, an increase of $28 billion from $42 billion in 2020-21, or from its current 23% share of PT health spending to 35%. CoF has also called for the CHT to grow by an annual escalator of at least 5% (March 4, 2021), and reiterated this demand on March 25th.

On March 25, 2021, the Government tabled Bill C-25 in Parliament, which will provide provinces and territories with an additional $5 billion for health care, including a $4 billion, one-time top-up to the CHT intended to support PTs to clear the backlog of procedures caused by waves one and two of the pandemic. Bill C-25 also provides PTs with $1 billion to support Canada’s COVID-19 immunization plan. Additionally, the Bill provides $2.2 billion to address infrastructure priorities. The $4 billion CHT top-up is in addition to the COVID-19 Response Fund that also provided one-time funding of $500 million through the CHT in 2019-20 to support PTs’ critical health care system needs and COVID-19 mitigation efforts.

Federal Commitment to the Health Accord (now referred to as the Common Statement of Principles on Shared Health Priorities):
In 2015, the Government committed to engage with the Provinces and Territories (PTs) to develop a new Health Accord, including a new long-term agreement on funding. The Government also committed to work jointly, and with Indigenous leaders, to explore areas of shared priority that will improve the health of Indigenous Peoples.

Federal Targeted Funding:
On March 22, 2017, Budget 2017 committed to $11 billion over 10 years to improve access to home care and mental health services as follows:
o $5 billion over 10 years, starting in 2017-18, for better home and palliative care, and $1 billion over 4 years, starting in 2018-19, to address critical home care infrastructure requirements; and,
o $5 billion over 10 years, starting in 2017-18, in support of mental health initiatives

This funding is in addition to the Canada Health Transfer (CHT), the largest major transfer to PTs. It provides long-term predictable funding for health care, and is tied to PTs’ respect for the principles of the Canada Health Act, which are: universality; comprehensiveness; portability; accessibility; and, public administration. In 2021-2022, PTs will receive $43.1 billion through the CHT.
Shared Health Priorities and Bilateral Agreements:
In August 2017, all PTs (except Quebec) agreed to a Common Statement of Principles on Shared Health Priorities, which sets out priorities for action in home and community care, and mental health and addiction services. On March 10, 2017, the Government of Canada and the Government of Quebec agreed to an asymmetrical arrangement distinct from this Common Statement of Principles and based on the asymmetrical agreements of September 2004.
The Common Statement also includes a commitment for PT governments to work with the Canadian Institute for Health Information on a set of common indicators in these areas, to continue collaborating to advance work in health innovation and prescription drugs, and to engage with Indigenous leaders to improve health outcomes for Indigenous peoples. At the June 2018 Health Ministers’ meeting, Health Ministers (except Quebec) endorsed a set of common indicators, developed by CIHI and FPT governments, to measure and report progress to Canadians on shared priorities.
Recognizing the unique circumstances in Nunavut, and to provide Nunavut the flexibility it required to implement initiatives that will improve access to home and community care and mental health and addiction services, it was agreed that the start date of the agreement would be delayed by a year, i.e., beginning 2019-20.

The funding is allocated to PTs on a per capita basis.
Renewal of Agreements:
The first year of funding (2017-18) flowed to PTs based on their acceptance of the federal funding offer, as outlined in the Budget Implementation Act, 2017, No. 1. The Government of Canada then engaged with PTs to negotiate detailed funding agreements for the 2018-19 to 2021-22 period. The Government of Canada will negotiate the renewal of these agreements in 2021-22 for the remaining five years (2022-23 to 2026-27). Bilateral agreements with all provinces and territories have been signed and are posted online.

Minister Hadju’s mandate letter from the Prime Minister outlines that the government will continue to work collaboratively with provinces and territories to strengthen Medicare. This work will include ensuring greater access to doctors or primary health teams, setting national standards for mental health access, and supporting home care and palliative care.
Safe Long-term Care:
The Fall Economic Statement announced a commitment of up to $1 billion for a Safe Long-term Care Fund, to help provinces and territories protect people in long-term care and support infection prevention and control. Funding will be contingent on a detailed spending plan, and conditional on provinces and territories demonstrating that investments have been made according to those spending plans. Provinces and territories will be able to use this funding to undertake a range of activities, including carrying out infection prevention and control readiness assessments, making improvements to ventilation and hiring additional staff or topping up wages.
Long-term Care Standards:
Budget 2021 proposes to provide $3B over five years to Health Canada to support provinces and territories in ensuring standards for long-term care are applied and permanent changes are made. The federal government will work collaboratively with provinces and territories, while respecting their jurisdiction over health care, including long-term care. This work would ensure seniors and those in care live in safe and dignified conditions.
The pandemic has shone a light on systemic issues affecting long-term care facilities across the country. The government welcomes the news that the Health Standards Organization and Canadian Standards Association are launching a process to help address those issues in Canada. The Health Standards Organization’s and Canadian Standards Association’s work with governments, stakeholders, and Canadians to develop national standards will help inform our ongoing discussions with provinces and territories on improving the quality of life of seniors in long-term care.
Virtual Care:
On May 3, the Prime Minister announced $240.5M to support virtual care and digital tools for Canadians. This funding will support the rapid roll out of virtual care and needed supports for health systems, as the Government of Canada is working with provinces and territories to assist health services to undertake virtual care and provide health services at a distance. Of this funding, $150M will flow to PTs through bilateral agreements for enhancements to virtual services focused on secure messaging and file transfer, secure videoconferencing, remote patient monitoring, patient online access to test results, and back-end supports to integrate these tools within existing digital systems.
In addition, Canada Health Infoway will receive up to $50M to develop pan-Canadian standards on secure messaging and videoconferencing and support PTs as they implement new initiatives pursuant to the bilateral agreements.

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